Provider Demographics
NPI:1285227751
Name:SOUTHERN, LAUREN PULLIAM (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:PULLIAM
Last Name:SOUTHERN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 PREMIER DR STE 307A
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-8356
Mailing Address - Country:US
Mailing Address - Phone:336-802-2685
Mailing Address - Fax:
Practice Address - Street 1:4515 PREMIER DR STE 307A
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8356
Practice Address - Country:US
Practice Address - Phone:336-802-2685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP20085225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist